Claims Supervisor

About the Role

The Claims Supervisor is responsible for supervising a staff of Claim Examiners and Claim Team Leads, 12-20 direct reports. The expectations include providing coaching, mentoring, and training while promoting quality and superior customer service. The Claims Supervisor is accountable for identifying opportunities for enhancements and changes to workflows to increase effectiveness and productivity of the team. Provides on-going feedback to the team and identifies areas for improvement and growth. Must be able to make independent decisions, prioritize workload effectively and collaborate with other internal departments to assist in meeting our corporate goals.

Primary Responsibilities

• Effectively supervise 12-20 direct reports—consisting of claim examiners and claim team leaders, including remote employees
• Provide full-time technical support to Claims, internal departments, vendors, and customers.
• Distribute daily work to the team and monitor aging inventory resolution.
• Train new hires, vendors, and existing staff as needed.
• Research and respond to escalated issues and pertinent information on claims requiring adjudication.
• Review and process High Dollar claims and conduct quality reviews of claims and logic changes/updates.
• Assist Customer Service in resolving customer questions and concerns.
• Researching and resolving client inquiries and performing client-requested claim adjustments.
• Coach, counsel, and mentor employees to meet quality, claims accuracy, and productivity standards, and address performance and disciplinary issues.
• Conduct audits as needed and manage payroll, timesheets, employee schedules, and time off requests.
• Perform quarterly Performance Evaluations and consistently host individual and team meetings with direct reports.

Essential Qualifications

• 3+ years of experience in supervisory or leadership role.
• Advanced knowledge of Excel.
• Strong knowledge of contracts, medical terminology, and claims processing and procedures.
• 5+ years of advanced claims adjudication experience, including facility, professional, and ancillary claims.
• Excellent written and oral communication, interpersonal, and negotiation skills with the ability to prioritize tasks.
• Problem-solving and organizational skills, ability to prioritize and multitask effectively.
• Ability to establish and maintain positive work relationships with clients, coworkers, members, providers, and customers.
• Enthusiastic attitude, cooperative team player, adaptable to new or changing circumstances.
• Bachelor's Degree or comparable experience in the healthcare field preferred.

About
At Brighton Health Plan Solutions, LLC, our people are committed to the improvement of how healthcare is accessed and delivered. When you join our team, you’ll become part of a diverse and welcoming culture focused on encouragement, respect and increasing diversity, inclusion, and a sense of belonging at every level. Here, you’ll be encouraged to bring your authentic self to work with all your unique abilities.

Brighton Health Plan Solutions partners with self-insured employers, Taft-Hartley Trusts, health systems, providers as well as other TPAs, and enables them to solve the problems facing today’s healthcare with our flexible and cutting-edge third-party administration services. Our unique perspective stems from decades of health plan management expertise, our proprietary provider networks, and innovative technology platform. As a healthcare enablement company, we unlock opportunities that provide clients with the customizable tools they need to enhance the member experience, improve health outcomes, and achieve their healthcare goals and objectives. Together with our trusted partners, we are transforming the health plan experience with the promise of turning today’s challenges into tomorrow’s solutions. Come be a part of the Brightest Ideas in Healthcare™.

Company Mission
Transform the health plan experience – how health care is accessed and delivered – by bringing outstanding products and services to our partners.

Company Vision
Redefine health care quality and value by aligning the incentives of our partners in powerful and unique ways.

DEI Purpose Statement 
At BHPS, we encourage all team members to bring your authentic selves to work with all your unique abilities. We respect how you experience the world and welcome you to bring the fullness of your lived experience into the workplace. We are building, nurturing, and embracing a culture focused on increasing diversity, inclusion and a sense of belonging at every level.
*We are an Equal Opportunity Employer